Hodgkin lymphoma (lymphogranulomatosis) is cancer that affects and destroys the human lymphatic system. With timely and competent treatment, up to 90% of patients recover. Systemic chemotherapy and radiation therapy are mostly used for Hodgkin lymphoma treatment.
Overview:
At the early stages of Hodgkin lymphoma, there are no specific cancer signs, and its first manifestation is usually an increase of lymph nodes in various body regions. In 60-75% of cases, the cancer process starts in the cervical and supraclavicular lymph nodes. In 15-20% of cancer patients, Hodgkin lymphoma begins with an increase in the lymph nodes of the mediastinum.
Starting in the lymph nodes, the cancer process can spread to almost all organs and tissue types. It is accompanied by intoxication that may be either mild or rather severe.
Hodgkin lymphoma most commonly affects the lung and bone tissue. Lung lesions may not be accompanied by severe cancer symptoms, and the involvement of bones in the process is manifested by pain. The cancer impact on the liver is detected late due to the large compensatory capabilities of this organ. The liver usually enlarges, the activity of alkaline phosphatase increases, and serum albumin level decreases.
Symptoms
fever, increased sweating, skin itching, and weight loss. Itching of the skin occurs in about 25-35% of people with Hodgkin lymphoma. It has different options of manifestation: from mild itching in a small area to generalized dermatitis with itching all over the body. Such itching is very painful for a patient with Hodgkin lymphoma; it deprives him of sleep and even leads to mental disorders.
Risk factors
Factors provoking Hodgkin lymphoma include:
Diagnostics
Doctors from oncology hospitals refer patients to several laboratory and instrumental examinations:
Additional examination methods that can be recommended to the patient include MRI, endoscopic examination, and bone scintigraphy.
Treatment:
Chemotherapy is one of cancer treatments that uses medication to suppress the cancer cells division by preventing their growth and/or cause their death.
Systemic and regional chemotherapy are applied for Hodgkin lymphoma treatment. The difference is that in systemic therapy with parenteral administration of drug solutions immediately get into systemic blood flow and can affect cancer cells of different localization. In regional therapy, they affect cancer cells in a chosen organ or a separate body cavity. Chemotherapy can be combined with targeted treatments.
Targeted therapy includes treatments of cancer with special antibodies manufactured in a laboratory. Such substances can identify certain proteins (receptors) of cancer cells and normal cells. When targeted drugs recognize specific receptors, they attach to them, destroy cancer cells, and suppress their growth factor.
As for the radiation therapy for Hodgkin lymphoma treatment, there were also breakthroughs. Earlier, the dose of radiation therapy was higher, and the whole body was irradiated. The better the primary diagnostics developed, the better doctors at oncology hospitals saw the affected area, and the more subtle the methods of radiation therapy became. Radiation therapy now hits exactly the target. When prescribing Hodgkin lymphoma treatments, radiation therapy specialists calculate the dose that is given to the tumor itself and the dose that is given to nearby tissues, prioritizing minimal damage to them.
At the same time, modern Hodgkin lymphoma treatments imply maximum efficiency at any stage. If after two courses of chemotherapy cancer doesn’t change the rate of progression, radiation therapy is started. If cancer slows down, it may not be treated with radiation therapy.
The precision of the stage of cancer identification before chemotherapy is very important in planning radiation therapy. Description of lesions according to information from clinical examinations, CT scan and MRI should include their anatomical localization and maximum dimensions in centimeters.
The main feature of radiation therapy as a component of multimodal Hodgkin lymphoma treatment is adjustment of dosages. Radiation therapy is performed before the chemotherapy program starts. An optimal interval between chemotherapy and radiation therapy is 2-4 weeks (but not more than 6 weeks).
The adjuvant radiation therapy is very important in predominant Hodgkin lymphoma treatment. Here it’s vital to assess the effectiveness and degree of toxicity of chemotherapy.
Radiation therapy is beneficial only in patients who have not achieved complete remission after chemotherapy, while in patients in complete remission, it is not needed.
The risk of secondary cancer development after radiation therapy for Hodgkin lymphoma treatment is 25% for 25 years. The curve of the development of secondary cancer does not reach a dangerous level. Moreover, for some cancers, the association with radiation therapy is dose dependent. For instance, the incidence of breast cancer after radiation therapy increases linearly at doses from 4 to 40 Gy.
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1-Diagnosis:
The program includes:
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 6 days
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2-Chemotherapy:
The program includes:
Required documents
Price from: on request
Type of program: Inpatient or outpatient (related to your diagnosis and treatment protocol).
Expected duration of the program: may differ and be related to your diagnosis and treatment protocol.
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The program includes:
How program is carried out
During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will conduct radiotherapy planning with the help of CT or MRI, make the permanent tattoo marks on the skin and conduct CT simulation to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).
Radiation therapy is carried out as an inpatient procedure, with mandatory admission to the hospital. Before each session the physician will assess your general condition and the marks on the skin. After that, you will be placed in a shielded radiation therapy room, on a special table.
Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will have from 1 to 3-5 sessions of radiation therapy a week.
After the completion of the radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 30 days
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The program includes:
How program is carried out
During the first visit, the doctor will conduct a clinical examination and go through the results of the available diagnostic tests. After that, you will undergo the necessary additional examination, such as the assessment of liver and kidney function, ultrasound scan, CT scan and MRI.
Also, the doctor will conduct a bone marrow biopsy followed by cytological examination of the harvested material. This will help him to determine the histological features of your bone marrow (in particular, identify HLA system antigens) and the use of a person’s own stem cells. They typically involve harvesting your cells before beginning a damaging therapy to cells like chemotherapy or radiation. After the treatment is done, your own cells are returned to your body.
This type of transplant isn’t always available. It can only be used if you have healthy bone marrow. However, it reduces the risk of some serious complications, including GVHD.
Before the procedure, you will receive chemotherapy, if necessary, in combination with radiation therapy. The course of chemo- or chemoradiation therapy lasts from 2 to 8 days.
The bone marrow transplant procedure is an intravenous infusion, i.e. the healthy bone marrow will be injected through a catheter, intravenously. You will stay in your room during the procedure. A bone marrow transplant is completely painless and does not require anesthesia.
During the period of healthy bone marrow engraftment, you will stay in a sterile ward. This is a necessary precaution because during this time your immune system is very weak and cannot withstand environmental pathogens. The risk of bleeding is also quite high, so you will be advised to avoid mechanical damage.
A relative or other close person may stay in the ward with you. You will not be allowed to go outside the department and leave your ward often. The rehabilitation period can last from 1 to 2 months.
When your complete blood count returns to normal, your doctor will schedule your discharge from the department. You will receive information about the rules that you will need to follow at home, the frequency and type of control examinations, and subsequent treatment measures. You will also receive a detailed medical report, which will reflect the entire course of treatment.
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 57 days
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